Studies on the Age of Onset of Colorectal Cancer and IBD

Patients with a longer duration of inflammatory bowel disease (IBD) have a higher cancer risk, but the exact operative approach and outcomes of these cancers has yet to be studied extensively. Robert Goldstone, MD, surgeon in the Division of Gastrointestinal and Oncologic Surgery at Massachusetts General Hospital, discusses his team's recent findings regarding the age of onset of colorectal cancer in patients with IBD.

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Transcript

Myself and some of the residents here that work with me performing research performed a study looking at the age of onset of colorectal cancer and age of onset of inflammatory bowel disease, to see trends in the two categories where you see that the younger patients known with longer disease duration had a higher incidence of cancer. While this is known, the exact operative approach or outcomes from these cancers determined by the disease duration or the age at onset of the disease has actually not been extensively studied.

While it was standard of care previously to do subtotal colectomies or total proctocolectomies in these patients, times have started shifting with the question of being able to do segmental colectomies. So when we looked at these groups, we looked at the operations performed, the disease duration, the grades of their cancer, the stage of their cancer, as well as their experience with recurrence of disease or survival. And what we interestingly found, was that the patients that were younger had extensive disease duration that was quite longer, as well as a severely active disease at the time of their colectomies for cancer.

In addition, we found that the patients that were older were more likely to undergo segmental colectomies, as opposed to the burden of a much larger operation such as a total proctocolectomy. Except it did not prove to be a great choice of surgery in the sense that they had significantly higher rates of recurrence of disease or metastatic disease. This is likely because a lot of the times that these patients with inflammatory bowel disease have cancer, they usually have metachronous dysplasia or other lesions that are actually difficult to detect.

In fact, certain studies have shown a decreased rate of detection of neoplasia or advanced neoplasia in inflammatory bowel disease patients by colonoscopy as compared to those that are just sporadic colorectal cancers.

I believe this is advancing our field by looking at these questions that remain and always looking for answers. So despite there being gold standards in textbooks or things that were commonly stated or performed, it's always best to reevaluate especially as time and medicine change, to see what is the optimal approach for care especially as times continue to change. For instance, the rate of cancer in inflammatory bowel disease used to be reported as high as 20% or 30% within 20 years of the disease. That rate is decreasing and a lot of people feel like it's not just environmental factors but could be improved surveillance with higher-end endoscopy, with better visualization versus the appropriate medicines that are decreasing the inflammation and prolonging the disease duration but reducing the degree of inflammation in those patients that have it. And so I find that addressing questions that do not have significant current research to answer, or data to answer those questions, can actually change the impact or surgical course or outcomes for patients.

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